Objectives
Patients with endocarditis requiring urgent valvular surgery with cardiopulmonary
bypass are at a high risk of developing systemic inflammatory response syndrome and
septic shock, necessitating intensive use of vasopressors after surgery. The use of
a cytokine hemoadsorber (CytoSorb, CytoSorbents Europe GmbH, Germany) during cardiac
surgery has been suggested to reduce the risk of inflammatory activation. The study
authors hypothesized that adding a cytokine adsorber would reduce cytokine burden,
which would translate into improved hemodynamic stability.
Design
A randomized, controlled, nonblinded clinical trial.
Setting
At a university hospital, tertiary referral center.
Participants
Nineteen patients with endocarditis undergoing valve surgery.
Intervention
A cytokine hemoadsorber integrated into the cardiopulmonary bypass circuit.
Measurements and Main Results
The accumulated norepinephrine dose in the intervention group was half or less at
all postoperative time points compared to the control group, although it did not reach
statistical significance; at 24 and 48 hours (median 36 [25-75 percentiles; 12-57]
μg v 114 [25-559] μg, p = 0.11 and 36 [12-99] μg v 261 [25-689] μg, p = 0.09). There was no significant difference in chest tube output,
but there was a significantly lower need for the transfusion of red blood cells (285
[0-657] mL v 1,940 [883-2,148] mL, p = 0.03).
Conclusions
There was no statistically significant difference between the groups with regard to
vasopressor use after surgery for endocarditis with the use of a cytokine hemoadsorber
during cardiopulmonary bypass. Additional, larger randomized controlled trials are
needed to definitely assess the potential effect.
Key Words
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Article info
Publication history
Published online: February 26, 2022
Footnotes
The cytokine hemadsorption cartridges were supplied by CytoSorbents Europe GmbH free of charge. The company had no impact on study design, writing or interpreting the data, or the decision to submit.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
